ATHEROCLEROSIS AS THE MAIN FACTOR OF CALCINOSIS OF THE HEART VALVE APPARATUS IN THE PREDIALYSIS PERIOD OF CHRONIC KIDNEY DISEASE

THE AIM of the investigation was to determine the incidence of calcinosis of the mitral (MV) and aortal (AV) heart valves in patients in the predialysis period of chronic kidney disease (CKD) and the associated factors. PATIENTS AND METHODS. The investigation included 317 patients (46.1% of men and 53.9% of women) with 1-5 stages of CKD in the predialysis period. The age of the patients was 50.7±15.2 years (14-84). There were 30.7% of patients with chronic glomerulonephritis, 29.4% with diabetic nephropathy, 17.7% with essential hypertension, 22.0% with other diseases. Doppleroechocardiography (Doppler-EchoCG), daily monitoring of AP, ECG were performed. The state of MV and AV was assessed: norm, hardening, calcinosis (of fibrous ring or cusps). The thickness of the carotid artery intima-media complex (IMC) was measured on two sides at 3 levels. In part of the patients the intact parathormone was determined, densitometry of the forearm bones was made, the thickness of cortical layers of the 2nd metacarpal bone was determined by X-ray examination, total extension of the abdominal aorta calcinosis was measured by the A.E.Hak el al. method. RESULTS. Valve calcinosis was detected in 22.1% of the first group patients: AV – in 6.3%, MV – in 4.1% and of the both valves in 11.7%. A comparison of the groups different in the presence of valve calcinosis (AV, MV or both) has shown that patients with calcinosis had greater thickness of IMC (p< 0.001), older age (p<0.001), more often incidence of diabetes mellitus (p<0.001), IHD (p<0.001), heart failure (p<0.001), higher AP (p<0.001), lower GFR by MDRD formula (p=0.033), less sizes of the kidneys (p=0.039) and their parenchyma thickness (p=0.015), tendency towards higher values of parathormone (p= 0.089). Using multifactor methods (discriminative analysis) revealed that valve calcinosis was independently influenced by IMC thichness (p=0.001) and diabetes mellitus (p=0.024). CONCLUSION. Heart valve calcinosis was revealed in 22.1% of the patients in the predialysis period of CKD. It was closely associated with atherosclerosis (in its turn associated with the patient’s age, hypertension, lower GFR, inflammatory alterations) and diabetes mellitus.

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